Trauma and QGH Surgery Referrals
The surgeon is available for advice at any time for any case if you need it. If in doubt, please call.
General Guidelines
The surgeon should not be called by personnel other than ED physician except for those circumstances where patient instability or other circumstances do not allow the physician to speak directly to the surgeon.
The surgeon should not be called until the patient arrives in the emergency department and has been properly assessed by the ED MD. Rarely, circumstances may arise where the ED physician has information suggestive of an incoming unusual or catastrophic injury that the surgeon might appreciate advance warning in order to better prepare (e.g. bleeding AAA, extremity vascular injury, and head injury with possible need for decompression). However, calling to inform the surgeon for a routine 'heads up' is generally not appreciated, particularly when the patient is being transported from outside Iqaluit.
If the surgeon comes in for a trauma call, the surgeon will determine if they will be taking over the case and assume role of trauma team leader. The surgeon will communicate their role to the ED physician and staff after arrival and assessment of patient.
Trauma patients should be assessed by the ED physician on call and not solely by the resident. If the resident is present when an unstable patient arrives, the supervising MD should be contacted immediately. Following assessment by the ED physician, the resident may call the surgeon if required.
Penetrating Trauma
Do not explore wounds.
The following circumstances require early surgeon notification. Continue resuscitation and workup until surgeon’s arrival:
Stab wound to the neck, chest, and abdomen.
Patient hemodynamically unstable, or has evisceration, active bleeding, or peritonitis.
Penetrating extremity trauma suggestive of neurovascular compromise.
Unstable gunshot wounds, particularly if to the neck, chest, and abdomen
Stable gunshot wounds: contact surgeon after initial assessment done by MD.
Blunt Trauma
The surgeon should be contacted early if the blunt trauma is accompanied with hemodynamic instability or peritonitis.
If serial hemoglobin (done one hour after original) has significantly dropped without explanation in an otherwise stable patient, get an ultrasound to assess for free fluid and call the surgeon when results are done.
Head Trauma
A surgery consult is required for emergent decompression of epidural/subdural bleeds when recommended by a consulting neurosurgeon in Ottawa
Extremity Trauma
The surgeon must be notified immediately for any fracture with vascular injury, nerve compression or compartment syndrome.
For any open fracture presenting less than 8 hours, contact the surgeon right away to decide on the urgency of irrigation (guidelines are evolving). If over 8 hours has elapsed from time of injury, there is no urgency to take open fractures to the operating room in the middle of the night for irrigation. Instead, please inform the surgeon at 8:00 am.
Generally, most of the surgeons here will not do fracture reductions in the operating room and will recommend that any fracture that the ED physician cannot manage be sent down to orthopedics.
Surgeons will take hip dislocations to the OR as well as shoulder dislocations that cannot be reduced in the emergency room.
For any patient with amputated digits/limbs, contact the Ottawa plastic surgeon on call for advice regarding potential for re-implantation.
The surgeons at QGH do not do flexor tendon repairs; these are sent down to plastics.
Surgical assist: Occasionally, this is done by family medicine residents, but if none are available, staff physicians and specifically the community pager staff may be asked to assist in the operating room.